I was off all supplements, vitamins and meds for a week prior, and was eating a "normal" diet - not vegetarian, not low-carb, not high-protein. Mostly just moderate protein at dinner, sometimes a bit at lunch.

Hi Valentijn - This an interesting test and I'm sorry to say that I certainly cannot interpret this test. I did have a couple of questions if you don't mind. 1) Where did you have this test performed and what is the name of the test? 2) Are you planning on posting the catacholamine results when they are available? I think "Rich" may be able to help with this interpretation some. Thanks!

richvank is the expert on this kind of stuff. Maybe you could PM him...

In any case, your Krebs cycle is clearly off. It seems that fumarate isn't getting converted to malate, for some reason, resulting in further downstream depletion. Problem with the enzyme fumarase? As I said, richvank is the expert here.

It's 4 different tests from the European Laboratory of Nutrients (the same one that does the methylation panel in the Netherlands and New Jersey). It just happens to be 20 minutes away, so it was easy to get it done there. First is serum neurotransmitters (results are pending - and will get posted), then 24 hour cortisol, then 24 hour amino acids, then the rest is from the organic acids.

The saliva cortisol results don't look too bad...the first stages of maladaption. The noon is a little low and the last sample is too high but your morning peak is still good as is your overall production. I would look into an herbal adrenal adaptogen like rhodiola or ashwaganda to see if the rhythm can be normalized a bit which should help if you have a noon time slump yet some trouble sleeping at night. A small dose of melatonin might help if you struggle with insomnia but I think I would try the adaptogen first.

I would also consider adding DHEA support as your level is quite low in my opinion and that is a very important adrenal hormone as well. Many feel that the lipid matrix form is preferable (or subling) in a dose of 5-25 mg is typical for women.

I'm sure you would do your own research but please make sure to read about Effexor withdrawals before you would think about starting this med. I know several people that have struggled for years with it but I am sure that everyone reacts differently.

Hmm, you are a prime candidate for Venlafaxine... Doesn't address the root cause but might be able to help you with your symptoms.

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Venlafaxine is an absolute nightmare drug -- worst withdrawals of any antidepressant.Just google for the nightmare stories (I've been there). Not only that, but because of the short half-life of the drug, you so much as take a dose too late or skip one by accident and you hit rapidly into withdrawals.

Extremely unpleasant.

If you absolutely had to go an SNRI, go the newer Duloxetine.

I wonder how accurately the level of these neurotransmitters in your platelets relflects neurotransmitters in the nervous system. Might have to do some googling.

Another option is to combine an SSRI with an NRI. I have combined fluoxetine with reboxetine in the past. I find several advantages with this approach.

First, you can start and stop each drug individually, so you won't titrate or withdraw both simultaneously. Usually, it's the SRI part of SNRIs that cause most of the withdrawal.

Secondly, there is halflife. For most SSRIs it's about 24 hours, which is much gentler. For reboxetine it's 13 hours. So you can have serotonin around the clock, but only NE in daytime. This helps with sleep.

Thirdly, the ratio of the SRI:NRI can be individually tailored.

I'm off the reboxetine now, and had no problems stopping it, besides a few days of increased fatigue.

The saliva cortisol results don't look too bad...the first stages of maladaption. The noon is a little low and the last sample is too high but your morning peak is still good as is your overall production. I would look into an herbal adrenal adaptogen like rhodiola or ashwaganda to see if the rhythm can be normalized a bit which should help if you have a noon time slump yet some trouble sleeping at night. A small dose of melatonin might help if you struggle with insomnia but I think I would try the adaptogen first.

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It looks great to me...yes a little bit low or slightly high later on, but overall, especially if you've been sick for a long time, your adrenals are in good shape. I'm jealous!

It looks great to me...yes a little bit low or slightly high later on, but overall, especially if you've been sick for a long time, your adrenals are in good shape. I'm jealous!

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Yeah, my cortisol isn't bad. It was worse in July when it first got tested. Then it started off too low and ended up too high. It was a similar pattern to the current measurement though, where there is a big drop between morning and noon, then it stays pretty level instead of steadily decreasing.

Hmm, you are a prime candidate for Venlafaxine... Doesn't address the root cause but might be able to help you with your symptoms.

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I think I'd rather try an NRI initially, since my biggest concern is with my OI problems, which low norepinephrine is probably causing. It also looks like anything impacting serotonin much can cause withdrawal problems, plus most of them can cause hypotension as a side effect. I'm most interested in atomoxetine (Strattera), since there's no withdrawal problems and it has a relatively minor effect on serotonin (I had problems with amitriptyline).

But first I want to try to figure out why my norepinephrine is so low. It sounds like angiotensin II controls the release of norepinphrine somewhat, so maybe I should get that checked out too. Etc

Coming off effexor I had nerve shocks (feels like your getting an electric shock -- not entirely sure of the "proper' name for it) and feeling like I'm going to collapse every time I turn my head. This went on for about 3 - 4 months! Not worth it at all and I'm far from the only person with those exact withdrawals. This was the first antidepressant I was ever put on and it was
FAR worse than anything else. Nothing else came close.